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Dhakal R, Lawrenson JG, Huntjens B, Shah R, Verkicharla PK. Light exposure profiles differ between myopes and non-myopes outside school hours. BMJ Open Ophthalmol 2024; 9:e001469. [PMID: 38816010 PMCID: PMC11138295 DOI: 10.1136/bmjophth-2023-001469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 04/27/2024] [Indexed: 06/01/2024] Open
Abstract
PURPOSE Considering the putative role of light in myopia, and variations in socioeconomic, lifestyle, educational and environmental factors across ethnicities, we objectively investigated light exposure patterns in Indian school children. METHODS The light exposure profile of 143 school children (9-15 years, 50 myopes) recorded using a validated wearable light tracker for six continuous days was analysed. Additional data for non-school days were available for 87 children (26 myopes). The illuminance exposure levels, time spent outdoors and epoch (number of times participant is exposed to a predefined range of lux level per day) were compared between myopes and non-myopes across different light conditions: ≥1000, ≥3000, ≥5000 and ≥10 000 lux. For school days, light exposure profiles during (1) before school, school and after school hours; and (2) class, break and transition (when a student travels to and from school) time were analysed. RESULTS The overall median (IQR) daily illuminance exposure level, time spent outdoors and epochs at outdoors (≥1000 lux) were 807 (507-1079) lux/day, 46 (30-64) min/day and 9 (6-12) times/day, respectively. The daily illuminance exposure on non-school days was significantly higher in non-myopes than myopes (6369 (4508-9112) vs 5623 (2616-6929) lux/day, p=0.04). During transition time (school days), non-myopes had significantly higher illuminance exposure (910 (388-1479) vs 550 (263-1098) lux/day, p=0.04), spent more time outdoors (25 (10-43) vs 14 (4-29) min/day, p=0.01) and had higher outdoor epochs (6 (4-11) vs 5 (2-8) times/day, p=0.01) than myopes. CONCLUSIONS A small but significant difference in illuminance exposure, time spent outdoors and epoch was noted between myopes and non-myopes during transition time, which may have implications in myopia control.
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Affiliation(s)
- Rohit Dhakal
- Myopia Research Lab, Prof. Brien Holden Eye Research Centre & Brien Holden Institute of Optometry and Vision Sceinces, LV Prasad Eye Institute, Hyderabad, India
- Centre for Applied Vision Research, City University of London, London, UK
| | - John G Lawrenson
- Centre for Applied Vision Research, City University of London, London, UK
| | - Byki Huntjens
- Centre for Applied Vision Research, City University of London, London, UK
| | - Rakhee Shah
- Centre for Applied Vision Research, City University of London, London, UK
| | - Pavan Kumar Verkicharla
- Myopia Research Lab, Prof. Brien Holden Eye Research Centre & Brien Holden Institute of Optometry and Vision Sceinces, LV Prasad Eye Institute, Hyderabad, India
- Infor Myopia Centre, L V Prasad Eye Institute, Hyderabad, India
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2
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Li D, Min S, Li X. Is Spending More Time Outdoors Able to Prevent and Control Myopia in Children and Adolescents? A Meta-Analysis. Ophthalmic Res 2024; 67:393-404. [PMID: 38710180 DOI: 10.1159/000539229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 04/29/2024] [Indexed: 05/08/2024]
Abstract
INTRODUCTION Spending more time outdoors was treated as a safe and cost-effective method to prevent and control myopia. While prior research has established an inverse association between outdoor time and the risk of myopia onset, the effect of increasing outdoor time in delaying the progression of myopia remains a subject of debate. The present meta-analysis aimed to assess the relationship between outdoor time and the myopia onset, and further examine whether there is a dose-response relationship between outdoor time and the risk of myopia onset. Meanwhile, perform whether the outdoor time is related to delaying the progression of myopia. METHODS Studies were retrieved from PubMed, Web of Science, Embase, Medline, and the Cochrane Database, spanning from their inception to February 2023. Three cohort studies and 5 prospective intervention studies were included, with a total of 12,922 participants aged 6-16 years. RESULTS Comparing the highest with the lowest exposure levels of time spent outdoors, the highest outdoor time was strongly associated with a reduced risk of myopia onset (odds ratio [OR]: 0.53; 95% confidence interval [CI]: 0.34, 0.82). A nonlinear dose-response relationship was found between outdoor time and myopia onset risk. Compared to 3.5 h of outdoor time per week, an increase to 7, 16.3, and 27 h per week corresponded with a respective reduction in the risk of myopia onset by 20%, 53%, and 69%. Among children and adolescents who were not myopic, spending more time outdoors significantly slowed down the speed of change in spherical equivalent refractive (weighted mean difference [WMD] = 0.10D, 95% CI: 0.07, 0.14) and axial length (WMD = -0.05 mm, 95% CI: -0.06, -0.03). Among children and adolescents who were already myopic, spending more time outdoors did not slow myopia progression. CONCLUSIONS Overall, spending more time outdoors can prevent the onset of myopia, but it does not seem to slow its progression. Further studies are needed to better understand these trends.
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Affiliation(s)
- Dan Li
- School of Physical Education, Hunan Normal University, Changsha, China
| | - Sicheng Min
- School of Physical Education, Hunan Normal University, Changsha, China
| | - Xianxiong Li
- School of Physical Education, Hunan Normal University, Changsha, China
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3
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Montanari A, Wang L, Birenboim A, Chaix B. Urban environment influences on stress, autonomic reactivity and circadian rhythm: protocol for an ambulatory study of mental health and sleep. Front Public Health 2024; 12:1175109. [PMID: 38375340 PMCID: PMC10875008 DOI: 10.3389/fpubh.2024.1175109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 01/02/2024] [Indexed: 02/21/2024] Open
Abstract
Introduction Converging evidence suggests that urban living is associated with an increased likelihood of developing mental health and sleep problems. Although these aspects have been investigated in separate streams of research, stress, autonomic reactivity and circadian misalignment can be hypothesized to play a prominent role in the causal pathways underlining the complex relationship between the urban environment and these two health dimensions. This study aims at quantifying the momentary impact of environmental stressors on increased autonomic reactivity and circadian rhythm, and thereby on mood and anxiety symptoms and sleep quality in the context of everyday urban living. Method The present article reports the protocol for a feasibility study that aims at assessing the daily environmental and mobility exposures of 40 participants from the urban area of Jerusalem over 7 days. Every participant will carry a set of wearable sensors while being tracked through space and time with GPS receivers. Skin conductance and heart rate variability will be tracked to monitor participants' stress responses and autonomic reactivity, whereas electroencephalographic signal will be used for sleep quality tracking. Light exposure, actigraphy and skin temperature will be used for ambulatory circadian monitoring. Geographically explicit ecological momentary assessment (GEMA) will be used to assess participants' perception of the environment, mood and anxiety symptoms, sleep quality and vitality. For each outcome variable (sleep quality and mental health), hierarchical mixed models including random effects at the individual level will be used. In a separate analysis, to control for potential unobserved individual-level confounders, a fixed effect at the individual level will be specified for case-crossover analyses (comparing each participant to oneself). Conclusion Recent developments in wearable sensing methods, as employed in our study or with even more advanced methods reviewed in the Discussion, make it possible to gather information on the functioning of neuro-endocrine and circadian systems in a real-world context as a way to investigate the complex interactions between environmental exposures, behavior and health. Our work aims to provide evidence on the health effects of urban stressors and circadian disruptors to inspire potential interventions, municipal policies and urban planning schemes aimed at addressing those factors.
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Affiliation(s)
- Andrea Montanari
- Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Sorbonne Universités, Paris, France
- Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France
| | - Limin Wang
- Department of Geography, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Amit Birenboim
- Department of Geography, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Basile Chaix
- Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Sorbonne Universités, Paris, France
- Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France
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Biswas S, El Kareh A, Qureshi M, Lee DMX, Sun CH, Lam JSH, Saw SM, Najjar RP. The influence of the environment and lifestyle on myopia. J Physiol Anthropol 2024; 43:7. [PMID: 38297353 PMCID: PMC10829372 DOI: 10.1186/s40101-024-00354-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 01/05/2024] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Myopia, commonly known as near-sightedness, has emerged as a global epidemic, impacting almost one in three individuals across the world. The increasing prevalence of myopia during early childhood has heightened the risk of developing high myopia and related sight-threatening eye conditions in adulthood. This surge in myopia rates, occurring within a relatively stable genetic framework, underscores the profound influence of environmental and lifestyle factors on this condition. In this comprehensive narrative review, we shed light on both established and potential environmental and lifestyle contributors that affect the development and progression of myopia. MAIN BODY Epidemiological and interventional research has consistently revealed a compelling connection between increased outdoor time and a decreased risk of myopia in children. This protective effect may primarily be attributed to exposure to the characteristics of natural light (i.e., sunlight) and the release of retinal dopamine. Conversely, irrespective of outdoor time, excessive engagement in near work can further worsen the onset of myopia. While the exact mechanisms behind this exacerbation are not fully comprehended, it appears to involve shifts in relative peripheral refraction, the overstimulation of accommodation, or a complex interplay of these factors, leading to issues like retinal image defocus, blur, and chromatic aberration. Other potential factors like the spatial frequency of the visual environment, circadian rhythm, sleep, nutrition, smoking, socio-economic status, and education have debatable independent influences on myopia development. CONCLUSION The environment exerts a significant influence on the development and progression of myopia. Improving the modifiable key environmental predictors like time spent outdoors and engagement in near work can prevent or slow the progression of myopia. The intricate connections between lifestyle and environmental factors often obscure research findings, making it challenging to disentangle their individual effects. This complexity underscores the necessity for prospective studies that employ objective assessments, such as quantifying light exposure and near work, among others. These studies are crucial for gaining a more comprehensive understanding of how various environmental factors can be modified to prevent or slow the progression of myopia.
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Affiliation(s)
- Sayantan Biswas
- School of Optometry, College of Health and Life Sciences, Aston University, Birmingham, UK
| | - Antonio El Kareh
- Faculty of Medical Sciences, Lebanese University, Hadath, Lebanon
| | - Mariyem Qureshi
- School of Optometry, College of Health and Life Sciences, Aston University, Birmingham, UK
| | | | - Chen-Hsin Sun
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Janice S H Lam
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Seang-Mei Saw
- Singapore Eye Research Institute, Singapore, Singapore
- Ophthalmology and Visual Science Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Raymond P Najjar
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
- Singapore Eye Research Institute, Singapore, Singapore.
- Ophthalmology and Visual Science Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore.
- Department of Biomedical Engineering, College of Design and Engineering, National University of Singapore, Singapore, Singapore.
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Chakraborty R, Seby C, Scott H, Tang V, Kemps E, Anstice N, Juers E, Lovato N, Taranath DA, Mills RA, Lack LC. Delayed melatonin circadian timing, lower melatonin output, and sleep disruptions in myopic, or short-sighted, children. Sleep 2024; 47:zsad265. [PMID: 37823859 DOI: 10.1093/sleep/zsad265] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/21/2023] [Indexed: 10/13/2023] Open
Abstract
STUDY OBJECTIVES This study investigated the differences in melatonin circadian timing and output, sleep characteristics, and cognitive function in myopic and non-myopic (or emmetropic) children, aged 8-15 years. METHODS Twenty-six myopes (refractive error [mean ± standard error mean] -2.06 ± 0.23 diopters) and 19 emmetropes (-0.06 ± 0.04 diopters), aged 11.74 ± 2.31 years were recruited. Circadian timing was assessed using salivary dim-light melatonin onset (DLMO), collected half-hourly for 7 hours, beginning 5 hours before and finishing 2 hours after individual average sleep onset in a sleep laboratory. Nocturnal melatonin output was assessed via aMT6s levels from urine voids collected from 05:30 pm to 8:00 am the following morning. Actigraphy-derived objective sleep timing were acquired for a week prior to the sleep laboratory visit. Cognitive assessments of sustained attention (using psychomotor vigilance task [PVT]) and working memory (using digit spans) were performed on the night of sleep laboratory. RESULTS Myopic children (9:07 pm ± 14 minutes) exhibited a DLMO phase-delay of 1 hour 8 minutes compared to emmetropes (7:59 pm ± 13 minutes), p = 0.002. aMT6s melatonin levels were significantly lower among myopes (18.70 ± 2.38) than emmetropes (32.35 ± 6.93, p = 0.001). Myopes also exhibited significantly delayed sleep onset, delayed wake-up time, poor and reduced sleep, and more evening-type diurnal preference than emmetropes (all p < 0.05). Finally, myopes showed a slower reaction time in the PVT (p < 0.05), but not digit span tasks at night. CONCLUSIONS These findings suggest a potential association between circadian rhythm dysfunction and myopia in children.
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Affiliation(s)
- Ranjay Chakraborty
- Flinders University, College of Nursing and Health Sciences, Caring Futures Institute, Myopia and Visual Development Lab, Adelaide, SA, Australia
| | - Chris Seby
- Flinders University, College of Nursing and Health Sciences, Caring Futures Institute, Myopia and Visual Development Lab, Adelaide, SA, Australia
| | - Hannah Scott
- Flinders University, Flinders Health and Medical Research Institute: Sleep Health, Adelaide, SA, Australia
| | - Victoria Tang
- Flinders University, College of Nursing and Health Sciences, Caring Futures Institute, Myopia and Visual Development Lab, Adelaide, SA, Australia
| | - Eva Kemps
- Flinders University, College of Education, Psychology and Social Work, Adelaide, SA, Australia
| | - Nicola Anstice
- Flinders University, College of Nursing and Health Sciences, Caring Futures Institute, Myopia and Visual Development Lab, Adelaide, SA, Australia
| | - Emilia Juers
- Flinders University, College of Nursing and Health Sciences, Caring Futures Institute, Myopia and Visual Development Lab, Adelaide, SA, Australia
| | - Nicole Lovato
- Flinders University, Flinders Health and Medical Research Institute: Sleep Health, Adelaide, SA, Australia
| | - Deepa A Taranath
- Department of Ophthalmology, Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA, Australia
| | - Richard A Mills
- Department of Ophthalmology, Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA, Australia
| | - Leon C Lack
- Flinders University, Flinders Health and Medical Research Institute: Sleep Health, Adelaide, SA, Australia
- Flinders University, College of Education, Psychology and Social Work, Adelaide, SA, Australia
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Shneor E, Gordon-Shaag A, Doron R, Benoit JS, Ostrin LA. Utility of the Actiwatch Spectrum Plus for detecting the outdoor environment and physical activity in children. JOURNAL OF OPTOMETRY 2024; 17:100483. [PMID: 37797567 PMCID: PMC10551654 DOI: 10.1016/j.optom.2023.100483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 05/24/2023] [Accepted: 06/25/2023] [Indexed: 10/07/2023]
Abstract
PURPOSE To describe the performance of the Actiwatch Spectrum Plus (Philips, Respironics) for determining real world indoor and outdoor environments and physical activity in children. METHODS Children wore the device while performing 10 different activities, ranging from sedentary to vigorous physical-activity, and under different indoor and outdoor conditions. Repeated measures ANOVA was implemented via mixed effects modeling to determine illuminance (lux) and physical activity (counts per 15 s, CP15) across conditions. Receiver operator characteristics (ROC) analysis assessed the accuracy to detect indoor versus outdoor settings. RESULTS Illuminance was found to be statistically different across indoor (793 ± 348 lux) and outdoor (4,413 ± 518 lux) conditions (P<.0001), with excellent diagnostic accuracy to detect indoor versus outdoor settings (Area under the ROC Curve, AUC 0.94); 1088 lux was identified as the optimal threshold for outdoor illuminance (sensitivity: 93.0%; specificity: 85.0%). Using published activity ranges, we found that when children were sitting, 94% of the physical-activity readings were classified as sedentary or light. When children were walking, 88% of readings were classified as light, and when children were running, 77% of readings were classified as moderate or vigorous. CONCLUSION The Actiwatch Spectrum Plus performed well during real world activities in children, showing excellent diagnostic accuracy at 1088 lux as a threshold to detect indoor versus outdoor environments and in categorizing physical activity.
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Affiliation(s)
- Einat Shneor
- Department of Optometry, Hadassah Academic College, Jerusalem 9101001, Israel.
| | - Ariela Gordon-Shaag
- Department of Optometry, Hadassah Academic College, Jerusalem 9101001, Israel
| | - Ravid Doron
- Department of Optometry, Hadassah Academic College, Jerusalem 9101001, Israel
| | - Julia S Benoit
- College of Optometry, University of Houston, Houston, TX 77004, USA; Texas Institute for Measurement, Evaluation, and Statistics, University of Houston, Houston, TX 77004, USA
| | - Lisa A Ostrin
- College of Optometry, University of Houston, Houston, TX 77004, USA
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7
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Liao S, Li X, Bai N, Wu D, Yang W, Wang F, Ji HZ. An empirical study on the effect of outdoor illumination and exercise intervention on Children's vision. Front Public Health 2023; 11:1270826. [PMID: 38155899 PMCID: PMC10754518 DOI: 10.3389/fpubh.2023.1270826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 11/28/2023] [Indexed: 12/30/2023] Open
Abstract
Objective To explore the relationship between outdoor lighting and sports and the development of myopia, and to analyze the effects of outdoor lighting and exercise on the diopter of children with normal vision and myopia, so as to provide guidance for the prevention and treatment of myopia in children and adolescents in the future. Methods A total of 201 children were divided into two groups according to myopia or not. Each group was randomly divided into 4 groups: outdoor exercise group, outdoor control group, indoor exercise group and indoor control group. Among them, the outdoor exercise group and indoor exercise group received moderate and high intensity aerobic exercise 3 times a week for 60 min each time for 12 months, while the outdoor control group and indoor control group had normal study and life during the corresponding period of time. No additional exercise intervention. At the end of the experiment, the diopter of each group was compared. Results The diopter of all groups with normal vision and myopia decreased significantly after the experiment (p < 0.01). There were significant differences in diopter between outdoor exercise group and indoor control group (p < 0.01), between outdoor exercise group and indoor control group (p < 0.05), and between indoor exercise group and indoor control group (p < 0.01). There were significant differences in diopter between indoor exercise group and indoor control group (p < 0.01). The differences among myopic children after the experiment showed that there was significant difference in diopter between outdoor exercise group and indoor exercise group (p < 0.05), between outdoor exercise group and indoor control group (p < 0.01), and between outdoor control group and indoor control group (p < 0.05). There were significant differences in the changes of diopter between the outdoor control group and the indoor exercise group with normal vision and myopia before and after the experiment (p < 0.05). Conclusion Outdoor light and exercise intervention can have a beneficial effect on children's vision, but because of whether children are myopic or not, the effect is different, outdoor light and exercise have a better effect on reducing the diopter of children with normal vision.
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Affiliation(s)
- Shuaixiong Liao
- Inner Mongolia University of Science and Technology, Baotou, China
| | - Xueying Li
- Inner Mongolia University of Science and Technology, Baotou, China
| | - Nan Bai
- Inner Mongolia University of Science and Technology, Baotou, China
| | | | - Wenliang Yang
- Inner Mongolia University of Science and Technology, Baotou, China
| | - Feng Wang
- Inner Mongolia University of Science and Technology, Baotou, China
| | - Hao Zong Ji
- Chongqing Liangjiang Yucai Middle School, Chongqing, China
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Wang B, Watt K, Chen Z, Kang P. Predicting the child who will become myopic - can we prevent onset? Clin Exp Optom 2023; 106:815-824. [PMID: 37194117 DOI: 10.1080/08164622.2023.2202306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 04/06/2023] [Indexed: 05/18/2023] Open
Abstract
Myopia has become a global epidemic with significant public health impacts. Identifying the child at risk of developing myopia, i.e. the pre-myopic child and implementing strategies to prevent the onset of myopia, could significantly reduce the burden of myopia on an individual and society. This paper is a review of publications that have identified ocular characteristics of children at risk of future myopia development including a lower than age normal amount of hyperopia and accelerated axial length elongation. Risk factors associated with increased risk of myopia development such as education exposure and reduced outdoor time, and strategies that could be implemented to prevent myopia onset in children are also explored. The strong causal role of education and outdoor time on myopia development suggests that lifestyle modifications could be implemented as preventative measures to at-risk children and may significantly impact the myopia epidemic by preventing or delaying myopia onset and its associated ocular health consequences.
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Affiliation(s)
- Bingjie Wang
- School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
| | - Kathleen Watt
- School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
| | - Zhi Chen
- Department of Ophthalmology, Fudan University Eye and ENT Hospital, Shanghai, China
| | - Pauline Kang
- School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
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Martínez-Albert N, Bueno-Gimeno I, Gené-Sampedro A. Risk Factors for Myopia: A Review. J Clin Med 2023; 12:6062. [PMID: 37763002 PMCID: PMC10532298 DOI: 10.3390/jcm12186062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/15/2023] [Accepted: 09/17/2023] [Indexed: 09/29/2023] Open
Abstract
Due to the myopia prevalence increase worldwide, this study aims to establish the most relevant risk factors associated with its development and progression. A review search was carried out using PubMed, Web of Science, and Scopus databases to identify the main myopia risk factors. The inclusion criteria for the articles were those related to the topic, carried out in subjects from 5 to 30 years, published between January 2000 and May 2023, in English, and with the full text available. Myopia etiology has proven to be associated with both genetic and environmental factors as well as with gene-environment interaction. The risk of developing myopia increases in children with myopic parents (one parent ×2 times, two parents ×5 times). Regarding environmental factors, education is the main risk factor correlated with myopia prevalence increase. Further, several studies found that shorter distance (<30 cm) and longer time spent (>30 min) for near work increase the risk of myopia. Meanwhile, increased outdoor activity (>40 min/day) has been shown to be a key factor in reducing myopia incidence. In conclusion, the interventional strategy suggested so far to reduce myopia incidence is an increase in time outdoors and a reduction in the time spent performing near-work tasks.
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Affiliation(s)
| | - Inmaculada Bueno-Gimeno
- Department of Optics and Optometry and Vision Sciences, University of Valencia, 46100 Burjassot, Spain;
| | - Andrés Gené-Sampedro
- Department of Optics and Optometry and Vision Sciences, University of Valencia, 46100 Burjassot, Spain;
- Research Institute on Traffic and Road Safety (INTRAS), University of Valencia, 46022 Valencia, Spain
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10
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Hönekopp A, Weigelt S. Using Light Meters to Investigate the Light-Myopia Association - A Literature Review of Devices and Research Methods. Clin Ophthalmol 2023; 17:2737-2760. [PMID: 37743889 PMCID: PMC10517690 DOI: 10.2147/opth.s420631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 08/18/2023] [Indexed: 09/26/2023] Open
Abstract
With the increasing prevalence of myopia, evaluating its relationship with objective light exposure as a potential adjustable environmental factor in myopia development has been an emerging research field in recent years. From a thorough literature search, we identify ten wearable light meters from human studies on light exposure and myopia and present an overview of their parameters, thereby demonstrating the wide between-device variability and discussing its implications. We further identify 20 publications, including two reanalyses, reporting investigations of light-myopia associations with data from human subjects wearing light meters. We thoroughly review the publications with respect to general characteristics, aspects of data collection, participant population, as well as data analysis and interpretation, and also assess potential patterns regarding the absence or presence of light-myopia associations in their results. In doing so, we highlight areas in which more research is needed as well as several aspects that warrant consideration in the study of light exposure and myopia.
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Affiliation(s)
- Astrid Hönekopp
- Department of Rehabilitation Sciences, Research Unit Vision, Visual Impairments & Blindness, TU Dortmund University, Dortmund, Germany
| | - Sarah Weigelt
- Department of Rehabilitation Sciences, Research Unit Vision, Visual Impairments & Blindness, TU Dortmund University, Dortmund, Germany
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11
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Wang J, Sankaridurg P, Naduvilath T, Li W, Morgan IG, Rose KA, Weng R, Xu X, He X. Time outdoors positively associates with academic performance: a school-based study with objective monitoring of outdoor time. BMC Public Health 2023; 23:645. [PMID: 37016357 PMCID: PMC10071681 DOI: 10.1186/s12889-023-15532-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 03/27/2023] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND To explore the relationship between outdoor time and academic performance among school-aged children. METHODS This study was designed as a cross-sectional study. Data were derived from a school-based prospective children myopia intervention study (STORM). Outdoor time was recorded by self-developed algorithm-validated wristwatches in real-time and calculated as the cumulative average of 10 months. The academic performance was recorded and provided by the participating schools and further standardized. Other information was collected using an online standardized questionnaire. Mixed-effects model and B-Spline method were used to investigate the association between time spent on different types of daily activity, including outdoor activity and academic performance. RESULTS A total of 3291 children with mean age 9.25 years were included in the final analysis. Overall, outdoor time was associated with academic performance in a non-linear manner; specifically, not exceeding 2.3 h per day, outdoor time was positively associated with academic performance; exceeding 2.3 h per day, this association became non-significant. Likewise, daily sleep duration and out-of-school learning time were associated with academic performance in a non-linear manner, resulting in turning points of 11.3 and 1.4 h per day, respectively. Separate analysis showed that outdoor time and sleep duration but not out-of-school learning time were positively associated with academic performance in Chinese, mathematics and English. CONCLUSION Outdoor time, sleep duration and out-of-school learning time were associated with academic performance in a non-linear manner. Promotion of outdoor time may not negatively impact on academic performance. TRIAL REGISTRATION Our study was registered in ClinicalTrials.gov (Identifier: NCT02980445).
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Affiliation(s)
- Jingjing Wang
- Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai Vision Health Center & Shanghai Children Myopia Institute, Shanghai, 200030, China
| | - Padmaja Sankaridurg
- Brien Holden Vision Institute, Sydney, Australia
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Thomas Naduvilath
- Brien Holden Vision Institute, Sydney, Australia
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Wayne Li
- Brien Holden Vision Institute, Sydney, Australia
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Ian G Morgan
- Division of Biochemistry and Molecular Biology, Research School of Biology, Australian National University, Canberra, ACT, Australia
| | - Kathryn A Rose
- Discipline of Orthoptics, Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Rebecca Weng
- Brien Holden Vision Institute, Sydney, Australia
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Xun Xu
- Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai Vision Health Center & Shanghai Children Myopia Institute, Shanghai, 200030, China
- Department of Ophthalmology, National Clinical Research Center for Eye Diseases, Center of Eye Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, 200080, China
| | - Xiangui He
- Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai Vision Health Center & Shanghai Children Myopia Institute, Shanghai, 200030, China.
- Department of Ophthalmology, National Clinical Research Center for Eye Diseases, Center of Eye Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, 200080, China.
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12
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Shneor E, Ostrin LA, Doron R, Benoit JS, Levine J, Davidson K, Gordon-Shaag A. Baseline characteristics in the Israel refraction, environment, and devices (iREAD) study. Sci Rep 2023; 13:2855. [PMID: 36806309 PMCID: PMC9938253 DOI: 10.1038/s41598-023-29563-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 02/07/2023] [Indexed: 02/19/2023] Open
Abstract
The purpose of this study is to present baseline data from a longitudinal study assessing behavioral factors in three groups of boys in Israel with varying myopia prevalence. Ultra-Orthodox (N = 57), religious (N = 67), and secular (N = 44) Jewish boys (age 8.6 ± 1.4 years) underwent cycloplegic autorefraction and axial-length measurement. Time-outdoors and physical-activity were assessed objectively using an Actiwatch. Ocular history, educational factors, and near-work were assessed with a questionnaire. Group effects were tested and mixed effects logistic and linear regression were used to evaluate behaviors and their relationship to myopia. The prevalence of myopia (≤ - 0.50D) varied by group (ultra-Orthodox: 46%, religious: 25%, secular: 20%, P < 0.021). Refraction was more myopic in the ultra-Orthodox group (P = 0.001). Ultra-Orthodox boys learned to read at a younger age (P < 0.001), spent more hours in school (P < 0.001), spent less time using electronic devices (P < 0.001), and on weekdays, spent less time outdoors (P = 0.02). Increased hours in school (OR 1.70) and near-work (OR 1.22), increased the odds of myopia. Being ultra-Orthodox (P < 0.05) and increased near-work (P = 0.007) were associated with a more negative refraction. Several factors were associated with the prevalence and degree of myopia in young boys in Israel, including being ultra-Orthodox, learning to read at a younger age, and spending more hours in school.
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Affiliation(s)
- Einat Shneor
- Department of Optometry, Hadassah Academic College, Haniviim St. 37, 9101001, Jerusalem, Israel.
| | - Lisa A. Ostrin
- grid.266436.30000 0004 1569 9707College of Optometry, University of Houston, Houston, TX 77004 USA
| | - Ravid Doron
- grid.443085.e0000 0004 0366 7759Department of Optometry, Hadassah Academic College, Haniviim St. 37, 9101001 Jerusalem, Israel
| | - Julia S. Benoit
- grid.266436.30000 0004 1569 9707Texas Institute for Measurement, Evaluation, and Statistics, Houston, TX 77004 USA
| | - Jonathan Levine
- grid.443085.e0000 0004 0366 7759Department of Optometry, Hadassah Academic College, Haniviim St. 37, 9101001 Jerusalem, Israel
| | - Kevin Davidson
- grid.266436.30000 0004 1569 9707Texas Institute for Measurement, Evaluation, and Statistics, Houston, TX 77004 USA
| | - Ariela Gordon-Shaag
- grid.443085.e0000 0004 0366 7759Department of Optometry, Hadassah Academic College, Haniviim St. 37, 9101001 Jerusalem, Israel
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13
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Balajadia E, Garcia S, Stampfli J, Schrader B, Guidolin C, Spitschan M. Usability and Acceptability of a Corneal-Plane α-Opic Light Logger in a 24-h Field Trial. Digit Biomark 2023; 7:139-149. [PMID: 37901367 PMCID: PMC10601946 DOI: 10.1159/000531404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 05/24/2023] [Indexed: 10/31/2023] Open
Abstract
Introduction Exposure to light fundamentally influences human physiology and behaviour by synchronising our biological clock to the external light-dark cycle and controlling melatonin production. In addition to well-controlled laboratory studies, more naturalistic approaches to examining these "non-visual" effects of light have been developed in recent years. As naturalistic light exposure is quite unlike well-controlled stimulus conditions in the laboratory, it is critical to measure light exposure in a person-referenced way, the "spectral diet." To this end, light loggers have been developed to capture personalised light exposure. As an alternative to light sensors integrated into wrist-worn actimeters, pendants, or brooch-based light loggers, a recently developed wearable light logger laterally attached to spectacle frames enables the measurement of biologically relevant quantities in the corneal plane. Methods Here, we examine the usability and acceptability of using the light logger in an undergraduate student sample (n = 18, mean±1SD: 20.1 ± 1.7 years; 9 female; Oxford, UK) in real-world conditions during a 24-h measurement period. We probed the acceptability of the light logger using rating questionnaires and open-ended questions. Results Our quantitative results show a modest acceptability of the light logger. A thematic analysis of the open-ended questions reveals that the form factor of the device, in particular, size, weight, and stability, and reactions from other people to the wearer of the light logger, were commonly mentioned aspects. Conclusion In sum, the results indicate the miniaturisation of light loggers and "invisible" integration into extant everyday objects as key areas for future technological development, facilitating the availability of light exposure data for developing personalised intervention strategies in both research, clinical and consumer contexts.
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Affiliation(s)
- Eljoh Balajadia
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Sophie Garcia
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Janine Stampfli
- Lucerne School of Engineering and Architecture, Horw, Switzerland
| | - Björn Schrader
- Lucerne School of Engineering and Architecture, Horw, Switzerland
| | - Carolina Guidolin
- Max Planck Institute for Biological Cybernetics, Translational Sensory & Circadian Neuroscience, Tübingen, Germany
| | - Manuel Spitschan
- Max Planck Institute for Biological Cybernetics, Translational Sensory & Circadian Neuroscience, Tübingen, Germany
- TUM School of Medicine and Health, Chronobiology & Health, Technical University of Munich, Munich, Germany
- Technical University of Munich, TUM Institute for Advanced Study (TUM-IAS), Garching, Germany
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14
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Li M, Lanca C, Tan CS, Foo LL, Sun CH, Yap F, Najjar RP, Sabanayagam C, Saw SM. Association of time outdoors and patterns of light exposure with myopia in children. Br J Ophthalmol 2023; 107:133-139. [PMID: 33858839 DOI: 10.1136/bjophthalmol-2021-318918] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/06/2021] [Accepted: 03/28/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND/AIMS To evaluate the association of reported time outdoors and light exposure patterns with myopia among children aged 9 years from the Growing Up in Singapore Towards Healthy Outcomes birth cohort. METHODS We assessed reported time outdoors (min/day), light exposure patterns and outdoor activities of children aged 9 years (n=483) with a questionnaire, the FitSight watch and a 7-day activity diary. Light levels, the duration, timing and frequency of light exposure were assessed. Cycloplegic spherical equivalent (SE), myopia (SE≤-0.5 D) and axial length (AL) of paired eyes were analysed using generalised estimating equations. RESULTS In this study, 483 (966 eyes) multiethnic children (50.0% boys, 59.8% Chinese, 42.2% myopic) were included. Reported time outdoors (mean±SD) was 100±93 min/day, and average light levels were 458±228 lux. Of the total duration children spent at light levels of ≥1000 lux (37±19 min/day), 76% were spent below 5000 lux. Peak light exposure occurred at mid-day. Children had 1.7±1.0 light exposure episodes/day. Common outdoor activities were walks, neighbourhood play and swimming. Greater reported time outdoors was associated with lower odds of myopia (OR=0.82, 95% CI 0.70 to 0.95/hour increase daily; p=0.009). Light levels, timing and frequency of light exposures were not associated with myopia, SE or AL (p>0.05). CONCLUSION Reported time outdoors, light levels and number of light exposure episodes were low among Singaporean children aged 9 years. Reported time outdoors was protective against myopia but not light levels or specific light measures. A multipronged approach to increase time outdoors is recommended in the combat against the myopia epidemic.
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Affiliation(s)
- Mijie Li
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore.,Myopia Research Group, Singapore Eye Research Institute, Singapore
| | - Carla Lanca
- Myopia Research Group, Singapore Eye Research Institute, Singapore
| | - Chuen-Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Li-Lian Foo
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,Ophthalmology and Visual Sciences Academic Clinical Programme, Duke-NUS Medical School, Singapore
| | - Chen-Hsin Sun
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Fabian Yap
- Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore
| | - Raymond P Najjar
- Ophthalmology and Visual Sciences Academic Clinical Programme, Duke-NUS Medical School, Singapore.,Visual Neuroscience Research Group, Singapore Eye Research Institute, Singapore
| | - Charumathi Sabanayagam
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,Ophthalmology and Visual Sciences Academic Clinical Programme, Duke-NUS Medical School, Singapore
| | - Seang-Mei Saw
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore .,Myopia Research Group, Singapore Eye Research Institute, Singapore.,Ophthalmology and Visual Sciences Academic Clinical Programme, Duke-NUS Medical School, Singapore
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15
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Minatoya Y, Shikano A, Tanabe K, Noi S. The relationship between light exposure and bedtime/wake-up time during school days, holidays and long-stay camp period in Japanese children. BIOL RHYTHM RES 2022. [DOI: 10.1080/09291016.2022.2151775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Yuji Minatoya
- Graduate School of Health and Sport Science, Nippon Sport Science University, Tokyo, Japan
| | - Akiko Shikano
- Research Institute for Health and Sport Science, Nippon Sport Science University, Tokyo, Japan
| | - Kosuke Tanabe
- Research Institute for Health and Sport Science, Nippon Sport Science University, Tokyo, Japan
- Faculty of Humanities and Social Sciences, Teikyo Heisei University, Tokyo, Japan
| | - Shingo Noi
- Research Institute for Health and Sport Science, Nippon Sport Science University, Tokyo, Japan
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16
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A Review of Intraocular Pressure (IOP) and Axial Myopia. J Ophthalmol 2022; 2022:5626479. [PMID: 35855886 PMCID: PMC9288324 DOI: 10.1155/2022/5626479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 06/16/2022] [Accepted: 06/17/2022] [Indexed: 11/18/2022] Open
Abstract
The pathogenesis of myopia is driven by genetic and environmental risk factors. Accommodation not only alters the curvature and shape of the lens but also involves contraction of the ciliary and extraocular muscles, which influences intraocular pressure (IOP). Scleral matrix remodeling has been shown to contribute to the biomechanical susceptibility of the sclera to accommodation-induced IOP fluctuations, resulting in reduced scleral thickness, axial length (AL) elongation, and axial myopia. The rise in IOP can increase the burden of scleral stretching and cause axial lengthening. Although the accommodation and IOP hypotheses were proposed long ago, they have not been validated. This review provides a brief and updated overview on studies investigating the potential role of accommodation and IOP in myopia progression.
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17
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Chakraborty R, Baranton K, Spiegel D, Lacan P, Guillon M, Barrau C, Villette T. Effects of mild‐ and moderate‐intensity illumination on short‐term axial length and choroidal thickness changes in young adults. Ophthalmic Physiol Opt 2022; 42:762-772. [DOI: 10.1111/opo.12988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 03/24/2022] [Accepted: 03/24/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Ranjay Chakraborty
- College of Nursing and Health Sciences, Optometry and Vision Science Flinders University Adelaide South Australia Australia
- Caring Futures Institute Flinders University Adelaide South Australia Australia
| | - Konogan Baranton
- Center Innovation & Technologies Europe Essilor International SAS Charenton‐le‐Pont France
| | | | - Pascale Lacan
- Center Innovation & Technologies Europe Essilor International SAS Charenton‐le‐Pont France
| | - Matthias Guillon
- Center Innovation & Technologies Europe Essilor International SAS Charenton‐le‐Pont France
| | - Coralie Barrau
- Center Innovation & Technologies Europe Essilor International SAS Charenton‐le‐Pont France
| | - Thierry Villette
- Center Innovation & Technologies Europe Essilor International SAS Charenton‐le‐Pont France
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18
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Lee SSY, Lingham G, Sanfilippo PG, Hammond CJ, Saw SM, Guggenheim JA, Yazar S, Mackey DA. Incidence and Progression of Myopia in Early Adulthood. JAMA Ophthalmol 2022; 140:162-169. [PMID: 34989764 PMCID: PMC8739830 DOI: 10.1001/jamaophthalmol.2021.5067] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
IMPORTANCE Myopia incidence and progression has been described extensively in children. However, few data exist regarding myopia incidence and progression in early adulthood. OBJECTIVE To describe the 8-year incidence of myopia and change in ocular biometry in young adults and their association with the known risk factors for childhood myopia. DESIGN, SETTING, AND PARTICIPANTS The Raine Study is a prospective single-center cohort study. Baseline and follow-up eye assessments were conducted from January 2010 to August 2012 and from March 2018 to March 2020. The data were analyzed from June to July 2021. A total of 1328 participants attended the baseline assessment, and 813 participants attended the follow-up assessment. Refractive information from both visits was available for 701 participants. Participants with keratoconus, previous corneal surgery, or recent orthokeratology wear were excluded. EXPOSURES Participants' eyes were examined at ages 20 years (baseline) and 28 years. MAIN OUTCOMES AND MEASURES Incidence of myopia and high myopia; change in spherical equivalent (SE) and axial length (AL). RESULTS A total of 516 (261 male [50.6%]) and 698 (349 male [50.0%]) participants without myopia or high myopia at baseline, respectively, were included in the incidences analyses, while 691 participants (339 male [49%]) were included in the progression analysis. The 8-year myopia and high myopia incidence were 14.0% (95% CI, 11.5%-17.4%) and 0.7% (95% CI, 0.3%-1.2%), respectively. A myopic shift (of 0.50 diopters [D] or greater in at least 1 eye) occurred in 261 participants (37.8%). Statistical significance was found in longitudinal changes in SE (-0.04 D per year; P < .001), AL (0.02 mm per year; P <.001), and lens thickness (0.02 mm per year; P < .001). Incident myopia was associated with self-reported East Asian vs White race (odds ratio [OR], 6.13; 95% CI, 1.06-35.25; P = .04), female vs male sex (OR, 1.81; 95% CI, 1.02-3.22; P = .04), smaller conjunctival ultraviolet autofluorescence area (per 10-mm2 decrease, indicating less sun exposure; OR, 9.86; 95% CI, 9.76-9.97; P = <.009), and parental myopia (per parent; OR, 1.57; 95% CI, 1.03-2.38; P = <.05). Rates of myopia progression and axial elongation were faster in female participants (estimate: SE, 0.02 D per year; 95 % CI, 0.01-0.02 and AL, 0.007 mm per year, 95 % CI, 0.00.-0.011; P ≤ .001) and those with parental myopia (estimate per parent: SE, 0.01 D per year; 95% CI, 0.00-0.02 and AL, 95% CI, 0.002-0.008; P ≤ .001). Education level was not associated with myopia incidence or progression. CONCLUSIONS AND RELEVANCE These findings suggest myopia progression continues for more than one-third of adults during the third decade of life, albeit at lower rates than during childhood. The protective effects of time outdoors against myopia may continue into young adulthood.
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Affiliation(s)
- Samantha Sze-Yee Lee
- Centre for Ophthalmology and Visual Science (incorporating Lions Eye Institute), The University of Western Australia, Perth, Australia
| | - Gareth Lingham
- Centre for Ophthalmology and Visual Science (incorporating Lions Eye Institute), The University of Western Australia, Perth, Australia,Centre for Eye Research Ireland, School of Physics, Clinical and Optometric Sciences, Technological University Dublin, Dublin, Ireland
| | - Paul G. Sanfilippo
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Christopher J. Hammond
- Department of Twin Research & Genetic Epidemiology, King’s College London, London, United Kingdom
| | - Seang-Mei Saw
- Singapore Eye Research Institute, Singapore,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jeremy A. Guggenheim
- School of Optometry and Vision Science, Cardiff University, Cardiff, United Kingdom
| | - Seyhan Yazar
- Garvan-Weizmann Centre for Cellular Genomics, Garvan Institute of Medical Research, Sydney, Australia
| | - David A. Mackey
- Centre for Ophthalmology and Visual Science (incorporating Lions Eye Institute), The University of Western Australia, Perth, Australia,Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, Melbourne, Australia,School of Medicine, Menzies Research Institute Tasmania, University of Tasmania, Hobart, Australia
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19
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Wen L, Cheng Q, Cao Y, Li X, Pan L, Li L, Zhu H, Mogran I, Lan W, Yang Z. The Clouclip, a wearable device for measuring near-work and outdoor time: validation and comparison of objective measures with questionnaire estimates. Acta Ophthalmol 2021; 99:e1222-e1235. [PMID: 33729708 DOI: 10.1111/aos.14785] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 10/26/2020] [Accepted: 01/12/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE To validate a novel wearable device that can measure both viewing distance and light exposure, Clouclip, and compare questionnaire estimates regarding near-work and outdoor time with the objective measures obtained using Clouclip. METHODS Fifteen Clouclips were selected to measure different distances and levels of illuminance. With each Clouclip, five measurements at different distances and light intensities were measured and recorded. Eighty participants wore Clouclips for a week and completed an activity questionnaire afterwards. RESULTS The intra- and inter-Clouclip coefficients were 1.00 and 0.99 for measuring distance and 1.00 and 1.00 for illuminance, respectively. Within the measurement limit, the maximum relative error was 2.07% for distance and 2.23% for illuminance. Assuming that <30 cm was the typical distance for near-work activities and >1000 Lux was the typical cut-off for outdoor environments, the questionnaire showed a trend of overestimation for both. The greatest overestimation of near-work occurred during the school period [Questionnaire: 4.73 hr (4.73, 5.07) versus Clouclip: 2.16 hr (1.74, 2.78); p < 0.01]. The greatest overestimation of outdoor activity also occurred during the school period [Questionnaire: 1.60 hr (1.33, 1.85) versus Clouclip: 1.21 hr (0.96, 1.50); p < 0.01]. Based on Clouclip, the total time spent outdoors was estimated to be 1.55 hr on school days, of which 0.34 hr occurred after school. For weekend days, however, the duration was only 0.17 hr. CONCLUSIONS Clouclip had excellent precision and accuracy. Although the agreement between the questionnaire and Clouclip was relatively poor, they were able to complement each other to provide a more logical and feasible assessment of exposure to near-work and outdoor activity. Indoor-oriented lifestyles were found to predominate in Chinese children.
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Affiliation(s)
- Longbo Wen
- Aier School of Ophthalmology Central South University Hunan China
| | - Qian Cheng
- State Key Laboratory of Software Development Environment Beihang University Beijing China
| | - Yingpin Cao
- Aier School of Ophthalmology Central South University Hunan China
| | - Xiaoning Li
- Aier School of Ophthalmology Central South University Hunan China
- Aier School of Optometry and Vision Science Hubei University of Science and Technology Hubei China
| | - Lun Pan
- Aier School of Ophthalmology Central South University Hunan China
- Aier School of Optometry and Vision Science Hubei University of Science and Technology Hubei China
| | - Lei Li
- State Key Laboratory of Software Development Environment Beihang University Beijing China
| | - Haogang Zhu
- Guangzhou Aier Eye Hospital Jinan University Guangdong China
| | - Ian Mogran
- Research School of Biology Australia National University Canberra ACT Australia
| | - Weizhong Lan
- Aier School of Ophthalmology Central South University Hunan China
- Aier School of Optometry and Vision Science Hubei University of Science and Technology Hubei China
- Guangzhou Aier Eye Hospital Jinan University Guangdong China
| | - Zhikuan Yang
- Aier School of Ophthalmology Central South University Hunan China
- Aier School of Optometry and Vision Science Hubei University of Science and Technology Hubei China
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20
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Shneor E, Doron R, Levine J, Zimmerman DR, Benoit JS, Ostrin LA, Gordon-Shaag A. Objective Behavioral Measures in Children before, during, and after the COVID-19 Lockdown in Israel. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168732. [PMID: 34444483 PMCID: PMC8394769 DOI: 10.3390/ijerph18168732] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/12/2021] [Accepted: 08/13/2021] [Indexed: 02/06/2023]
Abstract
Studies using questionnaires report that COVID-19 restrictions resulted in children spending significantly less time outdoors. This study used objective measures to assess the impact of pandemic-related restrictions on children’s behavior. A total of 19 healthy 8–12-year-old boys were observed before and during social restriction periods. Of these, 11 boys were reassessed after restrictions were lifted. For each session, Actiwatches were dispensed for measures of time outdoors, activity, and sleep. Changes overall and by school status were assessed using signed-rank test and Wilcoxon rank sum tests. During restrictions, children spent significantly less time outdoors (p = 0.001), were less active (p = 0.001), and spent less time engaged in moderate-to-vigorous physical activity (p = 0.004). Sleep duration was not significantly different between sessions (p > 0.99), but bedtime and wake time shifted to a later time during restrictions (p < 0.05 for both). Time outdoors and activity returned close to pre-pandemic levels after restrictions were lifted (p > 0.05 for both). Children’s behaviors significantly changed during the COVID-19 pandemic. The reduction in outdoor light exposure is of importance due to the role of light in the etiology of myopia and vitamin D production. The reduction in physical activity may have negative health effects in terms of obesity and depression, although further research is required to ascertain the long-term effects.
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Affiliation(s)
- Einat Shneor
- Department of Optometry, Hadassah Academic College, Jerusalem 9101001, Israel; (E.S.); (R.D.); (J.L.)
| | - Ravid Doron
- Department of Optometry, Hadassah Academic College, Jerusalem 9101001, Israel; (E.S.); (R.D.); (J.L.)
| | - Jonathan Levine
- Department of Optometry, Hadassah Academic College, Jerusalem 9101001, Israel; (E.S.); (R.D.); (J.L.)
| | - Deena Rachel Zimmerman
- Maternal Child and Adolescent Division Public Health Services, Israel Ministry of Health, Jerusalem 9101002, Israel;
| | - Julia S. Benoit
- Texas Institute for Measurement, Evaluation, and Statistics, Houston, TX 77004, USA;
- College of Optometry, University of Houston, Houston, TX 77004, USA;
| | - Lisa A. Ostrin
- College of Optometry, University of Houston, Houston, TX 77004, USA;
| | - Ariela Gordon-Shaag
- Department of Optometry, Hadassah Academic College, Jerusalem 9101001, Israel; (E.S.); (R.D.); (J.L.)
- Correspondence:
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21
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Gordon-Shaag A, Shneor E, Doron R, Levine J, Ostrin LA. Environmental and Behavioral Factors with Refractive Error in Israeli Boys. Optom Vis Sci 2021; 98:959-970. [PMID: 34387583 PMCID: PMC8407447 DOI: 10.1097/opx.0000000000001755] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 04/08/2021] [Indexed: 12/30/2022] Open
Abstract
SIGNIFICANCE Evidence supporting the contributions of near work in myopia is equivocal. Findings from this pilot study suggest that a high prevalence of myopia in ultra-Orthodox boys may be attributed to intense near work at school and learning to read in preschool at an early age. PURPOSE This study aimed to assess factors that may influence myopia in three groups of Jewish boys with different educational demands. METHODS Healthy ultra-Orthodox, religious, and secular Jewish boys (n = 36) aged 8 to 12 years participated. Refractive status, education, time spent reading and writing, and electronic device use were assessed using a questionnaire, and time outdoors and physical activity were assessed objectively using an Actiwatch. Data were analyzed with χ2 and Kruskal-Wallis tests with Bonferroni post hoc comparisons. RESULTS Ultra-Orthodox (n = 14) and religious (n = 13) children had greater myopia prevalence compared with secular children (n = 9; P = .01), despite no differences in parental myopia. Actigraph data showed that there were no differences in activity (P = .52) or time spent outdoors (P = .48) between groups. Ultra-Orthodox children learned to read at a younger age and spent more hours at school (P < .001 for both). All groups engaged in a similar amount of near work while not in school (P = .52). However, ultra-Orthodox boys had less electronic device use than did religious (P = .007) and secular children (P < .001). CONCLUSIONS This pilot study demonstrates that ultra-Orthodox, religious, and secular children have distinct educational demands but similar time outdoors, physical activity, and near work while not in school. The findings suggest that near work at school and/or learning to read in preschool at an early age may contribute to previously reported differences in refractive error between groups. However, conclusions should be confirmed in a larger sample size.
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Affiliation(s)
- Ariela Gordon-Shaag
- Department of Optometry, Hadassah Academic College Jerusalem, Jerusalem, Israel
| | - Einat Shneor
- Department of Optometry, Hadassah Academic College Jerusalem, Jerusalem, Israel
| | - Ravid Doron
- Department of Optometry, Hadassah Academic College Jerusalem, Jerusalem, Israel
| | - Jonathan Levine
- Department of Optometry, Hadassah Academic College Jerusalem, Jerusalem, Israel
| | - Lisa A. Ostrin
- College of Optometry, University of Houston, Houston, Texas
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22
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Bhandary SK, Dhakal R, Sanghavi V, Verkicharla PK. Ambient light level varies with different locations and environmental conditions: Potential to impact myopia. PLoS One 2021; 16:e0254027. [PMID: 34234353 PMCID: PMC8263252 DOI: 10.1371/journal.pone.0254027] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 06/17/2021] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Considering that time spent outdoors is protective for myopia, we investigated how ambient light levels reaching the eye varies across 9 outdoor and 4 indoor locations in 5 different environmental conditions. METHODS Illuminance (lux) was recorded using a lux meter under conditions of weather (sunny/cloudy), time of a day (7:00,10:00,13:00, and 16:00 hours), seasons (summer/winter), and sun protection (hat and cap) in outdoor and indoor locations. Nine outdoor locations were "open playground", "under a translucent artificial-shade", "under a porch facing east", "under a porch facing south", "under a big tree", "between three buildings", "within 4 buildings", and "canopy". As a ninth outdoor location, "Under a glass bowl" in the outdoor location was used as a simulation for "glass classroom model" and measurement was taken at the floor level only to determine in overall the illuminance conditions with glass covered on all sides. The 4 indoor locations included "room with multiple large windows", "room with combination light source", "room with multiple artificial lights", and "room with single artificial light". RESULTS The overall median illuminance level (median; Q1-Q3) recorded in 9 outdoor locations was 8 times higher than that of all indoor locations (1175;197-5400 lux vs. 179;50-333 lux). Highest illuminance in outdoor locations was recorded in "open playground" (9300;4100-16825 lux), followed by "under a translucent artificial shade (8180;4200-13300 lux) and the lowest in "within 4 buildings" (11;6-20 lux). Illuminance under 'Canopy', 'between three buildings' and 'within four buildings' was similar to that of indoor locations (<1000 lux). Time of the day, weather, season, sensor position and using sun protection did not alter illuminance to change from high to low level (>1000 to <1000 lux). Among indoor locations, illuminance in "room with multiple large windows" crossed 1000 lux at a specific time points on both sunny and cloudy days. CONCLUSIONS Illuminance levels in outdoors and indoors varied with location type, but not with other conditions. Given the variation in illuminance in different locations, and the impact it may have on myopia control, appropriate detailed recommendations seems necessary while suggesting time outdoors as an anti-myopia strategy to ensure desired outcomes.
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Affiliation(s)
- Shashank Kishore Bhandary
- Prof. Brien Holden Eye Research Centre, Myopia Research Lab, Brien Holden Institute of Optometry and Vision Sciences, L V Prasad Eye Institute, Hyderabad, India
| | - Rohit Dhakal
- Prof. Brien Holden Eye Research Centre, Myopia Research Lab, Brien Holden Institute of Optometry and Vision Sciences, L V Prasad Eye Institute, Hyderabad, India
| | - Vishwa Sanghavi
- Prof. Brien Holden Eye Research Centre, Myopia Research Lab, Brien Holden Institute of Optometry and Vision Sciences, L V Prasad Eye Institute, Hyderabad, India
| | - Pavan Kumar Verkicharla
- Prof. Brien Holden Eye Research Centre, Myopia Research Lab, Brien Holden Institute of Optometry and Vision Sciences, L V Prasad Eye Institute, Hyderabad, India
- * E-mail:
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23
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Muralidharan AR, Lança C, Biswas S, Barathi VA, Wan Yu Shermaine L, Seang-Mei S, Milea D, Najjar RP. Light and myopia: from epidemiological studies to neurobiological mechanisms. Ther Adv Ophthalmol 2021; 13:25158414211059246. [PMID: 34988370 PMCID: PMC8721425 DOI: 10.1177/25158414211059246] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 10/25/2021] [Indexed: 12/22/2022] Open
Abstract
Myopia is far beyond its inconvenience and represents a true, highly prevalent, sight-threatening ocular condition, especially in Asia. Without adequate interventions, the current epidemic of myopia is projected to affect 50% of the world population by 2050, becoming the leading cause of irreversible blindness. Although blurred vision, the predominant symptom of myopia, can be improved by contact lenses, glasses or refractive surgery, corrected myopia, particularly high myopia, still carries the risk of secondary blinding complications such as glaucoma, myopic maculopathy and retinal detachment, prompting the need for prevention. Epidemiological studies have reported an association between outdoor time and myopia prevention in children. The protective effect of time spent outdoors could be due to the unique characteristics (intensity, spectral distribution, temporal pattern, etc.) of sunlight that are lacking in artificial lighting. Concomitantly, studies in animal models have highlighted the efficacy of light and its components in delaying or even stopping the development of myopia and endeavoured to elucidate possible mechanisms involved in this process. In this narrative review, we (1) summarize the current knowledge concerning light modulation of ocular growth and refractive error development based on studies in human and animal models, (2) summarize potential neurobiological mechanisms involved in the effects of light on ocular growth and emmetropization and (3) highlight a potential pathway for the translational development of noninvasive light-therapy strategies for myopia prevention in children.
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Affiliation(s)
| | | | | | | | | | | | - Dan Milea
- Singapore Eye Research Institute, Singapore
| | - Raymond P Najjar
- Visual Neurosciences Group, Singapore Eye Research Institute, The Academia, 20 College Road, Discovery Tower Level 6, Singapore 169856
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24
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Yotsukura E, Torii H, Ozawa H, Hida RY, Shiraishi T, Corso Teixeira I, Rautha YVBL, Moraes do Nascimento CF, Mori K, Uchino M, Kurihara T, Negishi K, Tsubota K. Axial Length and Prevalence of Myopia among Schoolchildren in the Equatorial Region of Brazil. J Clin Med 2020; 10:jcm10010115. [PMID: 33396242 PMCID: PMC7794886 DOI: 10.3390/jcm10010115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 12/26/2020] [Accepted: 12/27/2020] [Indexed: 12/14/2022] Open
Abstract
The prevalence of myopia is increasing globally, and the outdoor light environment is considered as a possible factor that can retard myopia. The aim of this study was to evaluate the prevalence of myopia and the light environment in Aracati, equatorial Brazil. We surveyed 421 children (421 right eyes; mean age, 10.6 years) and performed ocular examinations that included non-cycloplegic refraction and axial length (AL). Multiple regression analyses were performed to identify factors affecting myopia such as time spent outdoors and in near work. We measured illuminance and violet light irradiance in Aracati. The mean spherical equivalent (SE) and AL were −0.44 ± 1.38 diopters (D) and 22.98 ± 0.87 mm, respectively. The prevalence of myopia (SE ≤ −0.75 D) and high myopia (SE ≤ −6.0 D/AL ≥ 26.0 mm) was 20.4 and 1.4/0.48%, respectively. Multiple regression analyses showed that myopia was not associated with lifestyle factors. The average illuminance in Aracati was about 100,000 lux from morning to evening. The current results reflect the ALs and the prevalence of myopia among Brazilian schoolchildren. There is a possibility that the light environment in addition to other confounding factors including racial differences affects the ALs and refractive errors.
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Affiliation(s)
- Erisa Yotsukura
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan; (E.Y.); (H.T.); (H.O.); (R.Y.H.); (K.M.); (M.U.)
- Laboratory of Photobiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Hidemasa Torii
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan; (E.Y.); (H.T.); (H.O.); (R.Y.H.); (K.M.); (M.U.)
- Laboratory of Photobiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Hiroko Ozawa
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan; (E.Y.); (H.T.); (H.O.); (R.Y.H.); (K.M.); (M.U.)
| | - Richard Yudi Hida
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan; (E.Y.); (H.T.); (H.O.); (R.Y.H.); (K.M.); (M.U.)
- Department of Ophthalmology, Universidade de Sao Paulo, Av. Dr. Enéas Carvalho de Aguiar, 255-Cerqueira César, São Paulo SP 05402-000, Brazil;
- Department of Ophthalmology, Universidade Federal de Sao Paulo, R. Botucatu, 822-Vila Clementino, São Paulo SP 04039-032, Brazil
| | - Tetsuro Shiraishi
- Department of Obstetrics and Gynecology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan;
| | - Ivan Corso Teixeira
- Department of Ophthalmology, Santa Casa de Sao Paulo, Rua Dr. Cesario Mota Junior, 112-Vila Buarque, São Paulo SP 01221-010, Brazil; (I.C.T.); (C.F.M.d.N.)
| | | | - Caio Felipe Moraes do Nascimento
- Department of Ophthalmology, Santa Casa de Sao Paulo, Rua Dr. Cesario Mota Junior, 112-Vila Buarque, São Paulo SP 01221-010, Brazil; (I.C.T.); (C.F.M.d.N.)
| | - Kiwako Mori
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan; (E.Y.); (H.T.); (H.O.); (R.Y.H.); (K.M.); (M.U.)
- Laboratory of Photobiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Miki Uchino
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan; (E.Y.); (H.T.); (H.O.); (R.Y.H.); (K.M.); (M.U.)
| | - Toshihide Kurihara
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan; (E.Y.); (H.T.); (H.O.); (R.Y.H.); (K.M.); (M.U.)
- Laboratory of Photobiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
- Correspondence: (T.K.); (K.N.); (K.T.); Tel.: +81-3-5363-3204 (T.K.); +81-3-3353-1211 (K.N.); +81-3-3353-1211 (K.T.)
| | - Kazuno Negishi
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan; (E.Y.); (H.T.); (H.O.); (R.Y.H.); (K.M.); (M.U.)
- Correspondence: (T.K.); (K.N.); (K.T.); Tel.: +81-3-5363-3204 (T.K.); +81-3-3353-1211 (K.N.); +81-3-3353-1211 (K.T.)
| | - Kazuo Tsubota
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan; (E.Y.); (H.T.); (H.O.); (R.Y.H.); (K.M.); (M.U.)
- Tsubota Laboratory, Inc., 304 Toshin Shinanomachi-Ekimae Bldg., 34 Shinanomachi Shinjuku-ku, Tokyo 160-0016, Japan
- Correspondence: (T.K.); (K.N.); (K.T.); Tel.: +81-3-5363-3204 (T.K.); +81-3-3353-1211 (K.N.); +81-3-3353-1211 (K.T.)
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25
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Bhandari KR, Ostrin LA. Validation of the Clouclip and utility in measuring viewing distance in adults. Ophthalmic Physiol Opt 2020; 40:801-814. [PMID: 33002229 DOI: 10.1111/opo.12735] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 08/20/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE To validate the Clouclip, a continuously measuring objective rangefinder, and examine viewing behaviours during various near tasks in non-myopic and myopic adults. METHODS In experiment 1, five Clouclip devices were utilised. An infrared camera was used to visualise and measure infrared beam size and angle. Repeatability for distance tracking was assessed from 5 to 120 cm in 5 cm increments. Accuracy of distance tracking was investigated for paper and iPad targets, spatial integration was calculated, effects of target tilt were determined and light measurements were compared to a lux meter. In experiment 2, viewing behaviour was assessed in 41 subjects (21 non-myopic, 20 myopic) during four 15-min near tasks; (1) passive reading of printed material, (2) active writing on printed material, (3) passive viewing on an electronic device and (4) active engagement on an electronic device. Working distance was compared between tasks and refractive error groups. RESULTS Clouclip distance tracking showed good repeatability, with a mean difference of 0.34 cm and limits of agreement of ±2.0 cm. Clouclip-measured and actual distances were highly correlated for paper and electronic targets from 5 to 120 cm, with mean differences and limits of agreement of 3.96 ± 13.78 cm and 4.48 ± 8.92 cm, respectively; variability increased for distances >100 cm. Tracking ability increased with larger target sizes; tracking was accurate when the target occupied 1.5%-20.3% of tracking beam area, depending on distance and with target tilt up to ±60 degrees. Clouclip- and lux meter-measured ambient illumination were highly correlated for a wide range of intensities (r = 0.96, p < 0.001), but with greater variability for intensities >20 000 lux. The Clouclip infrared beam was measured to have a diameter of 25.6 ± 2.2° and a downward angle of 10.3 ± 0.5°. For subject testing, viewing distance was significantly closer for active and passive printed tasks (29.5 ± 6.7 cm and 33.2 ± 8.8 cm, respectively) than for active and passive electronic tasks (35.4 ± 8.0 cm and 40.8 ± 10.4 cm, respectively), with no differences between refractive error groups (p = 0.88). CONCLUSIONS The Clouclip performed well in measuring near and intermediate distances and could distinguish between indoor (<1000 lux) and outdoor (>1000 lux) illumination. A closer working distance was observed for printed tasks compared to those on an iPad, with no difference in viewing distance between non-myopic and myopic adults.
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Affiliation(s)
| | - Lisa A Ostrin
- University of Houston College of Optometry, Houston, USA
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26
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Lee SSY, Mackey DA, Lingham G, Crewe JM, Richards MD, Chen FK, Charng J, Ng F, Flitcroft I, Loughman JJ, Azuara-Blanco A, Logan NS, Hammond CJ, Chia A, Truong TT, Clark A. Western Australia Atropine for the Treatment of Myopia (WA-ATOM) study: Rationale, methodology and participant baseline characteristics. Clin Exp Ophthalmol 2020; 48:569-579. [PMID: 32100917 DOI: 10.1111/ceo.13736] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 02/09/2020] [Accepted: 02/18/2020] [Indexed: 01/23/2023]
Abstract
IMPORTANCE Atropine eyedrops are a promising treatment for slowing myopia progression in East Asian children. However, its effects on children in Australia, including those of non-Asian background, have not been well-studied. BACKGROUND The Western Australia Atropine for the Treatment of Myopia (WA-ATOM) study aims to determine the efficacy and long-term effects of low-dose atropine eyedrops in myopia control. This paper describes the study rationale, methodology and participant baseline characteristics. DESIGN Single-centre, double-masked, randomized controlled trial. PARTICIPANTS Children (6-16 years) with spherical equivalent ≤-1.50 D in each eye, astigmatism ≤1.50 D and myopia progression by ≥0.50 D/year. METHODS Enrolled children were randomly assigned 2:1 to receive 0.01% atropine or placebo eyedrops. Participants are examined every 6 months during first 3 years of the study (2-year treatment phase followed by a 1-year washout phase), and then at a 5-year follow-up (2 years after the end of the washout phase). MAIN OUTCOME MEASURES Annual progression rate of myopia and axial length, tolerability to eyedrops and incidence and severity of unwanted effects. RESULTS Out of 311 children who were referred, 242 were suitable for study participation, and 153 were subsequently enrolled. The baseline characteristics of enrolled participants are presented. CONCLUSIONS AND RELEVANCE Outcomes of the WA-ATOM study will inform on the efficacy, tolerability, safety and long-term effects of low-dose atropine eyedrops in myopia control in Australian children. The impact of ocular sun exposure, iris colour and parental myopia on the efficacy of low-dose atropine will also be assessed.
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Affiliation(s)
- Samantha S Y Lee
- Centre for Ophthalmology and Visual Sciences (incorporating Lions Eye Institute), University of Western Australia, Perth, Western Australia, Australia
| | - David A Mackey
- Centre for Ophthalmology and Visual Sciences (incorporating Lions Eye Institute), University of Western Australia, Perth, Western Australia, Australia.,Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, Victoria, Australia.,School of Medicine, Menzies Research Institute Tasmania, University of Tasmania, TAS, Australia
| | - Gareth Lingham
- Centre for Ophthalmology and Visual Sciences (incorporating Lions Eye Institute), University of Western Australia, Perth, Western Australia, Australia
| | - Julie M Crewe
- Centre for Ophthalmology and Visual Sciences (incorporating Lions Eye Institute), University of Western Australia, Perth, Western Australia, Australia
| | - Michael D Richards
- Centre for Ophthalmology and Visual Sciences (incorporating Lions Eye Institute), University of Western Australia, Perth, Western Australia, Australia.,Department of Ophthalmology, Max Rady College of Medicine, University of Manitoba, Canada
| | - Fred K Chen
- Centre for Ophthalmology and Visual Sciences (incorporating Lions Eye Institute), University of Western Australia, Perth, Western Australia, Australia.,Department of Ophthalmology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Jason Charng
- Centre for Ophthalmology and Visual Sciences (incorporating Lions Eye Institute), University of Western Australia, Perth, Western Australia, Australia
| | - Fletcher Ng
- Centre for Ophthalmology and Visual Sciences (incorporating Lions Eye Institute), University of Western Australia, Perth, Western Australia, Australia
| | - Ian Flitcroft
- Department of Ophthalmology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - James J Loughman
- Centre for Eye Research Ireland, School of Physics, Clinical and Optometric Sciences, Technological University Dublin, Dublin, Ireland
| | - Augusto Azuara-Blanco
- School of Medicine Dentistry, and Biomedical Science, Queen's University Belfast, Ireland
| | - Nicola S Logan
- School of Life & Health Sciences, Aston University, Birmingham, UK
| | - Christopher J Hammond
- Department of Twin Research and Genetic Epidemiology, King's College London, St. Thomas' Hospital, London, UK
| | - Audrey Chia
- Singapore National Eye Centre, Singapore.,Singapore Eye Research Institute, Singapore
| | - Tan Tai Truong
- Oxford Compounding, North Perth, Western Australia, Australia
| | - Antony Clark
- Centre for Ophthalmology and Visual Sciences (incorporating Lions Eye Institute), University of Western Australia, Perth, Western Australia, Australia
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27
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Zhang L, Qu X. The Effects of High Lighting on the Development of Form-Deprivation Myopia in Guinea Pigs. Invest Ophthalmol Vis Sci 2020; 60:4319-4327. [PMID: 31622468 DOI: 10.1167/iovs.18-25258] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To investigate the effects of high ambient lighting on refraction and ocular biometry in guinea pig models of form-deprivation myopia (FDM). Methods Forty 3-week-old guinea pigs were randomly assigned to groups exposed to either high light (HL, 10,000 lux) or normal light (NL, 500 lux) with normal vision or form deprivation. Throughout the 10-week rearing period, animals were exposed to high light or normal light for 12 hours with a 12-hour light/dark cycle. Refraction, axial length (AL), and radius of corneal curvature (CCR) were measured by cycloplegic retinoscopy, A-scan ultrasonography, and keratometer, respectively. Results At the end of treatment, form-deprived eyes under high ambient lighting exhibited more hyperopic refraction and shorter AL than those under normal ambient lighting (2.06 ± 1.68 diopters [D; mean ± SD] vs. -0.59 ± 1.56 D, P < 0.001; 8.36 ± 0.13 mm vs. 8.56 ± 0.16 mm, P < 0.001). Deprived eyes under high ambient lighting were relatively more myopic than their contralateral control eyes at the end of treatment (2.06 ± 1.68 D vs. 5.44 ± 0.66 D, P < 0.001). High lighting induced a significant hyperopic shift in normal eyes after 4 weeks of exposure. There were no significant differences in CCR between eyes exposed to high and normal light, nor between deprived eyes and contralateral eyes. Conclusions High ambient lighting could retard, but not fully inhibit, the development of FDM. High light levels contributed to a greater hyperopic shift in normal eyes during the first 4 weeks of treatment. Corneal curvature was unaffected by either high ambient lighting or form deprivation.
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Affiliation(s)
- Luoli Zhang
- Department of Ophthalmology and Vision Science, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Xiaomei Qu
- Department of Ophthalmology and Vision Science, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
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28
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Maternal Lutein and Zeaxanthin Concentrations in Relation to Offspring Visual Acuity at 3 Years of Age: The GUSTO Study. Nutrients 2020; 12:nu12020274. [PMID: 31972973 PMCID: PMC7070638 DOI: 10.3390/nu12020274] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 01/15/2020] [Accepted: 01/20/2020] [Indexed: 12/18/2022] Open
Abstract
Lutein and zeaxanthin play important roles in visual functions, but their influence on early visual development is unclear. We related maternal lutein and zeaxanthin concentrations during pregnancy to offspring visual acuity (VA) in 471 mother–child pairs from the Growing Up in Singapore Towards healthy Outcomes (GUSTO) cohort. Maternal concentrations of plasma lutein and zeaxanthin were determined at delivery. We measured uncorrected distance of VA in 3-year old children using a LEA Symbols chart; readings were converted to the logarithm of Minimum Angle of Resolution (logMAR), with >0.3 logMAR indicating poor VA. Associations were examined using linear or Poisson regression adjusted for confounders. The median (inter-quartile range) of maternal lutein and zeaxanthin concentrations were 0.13 (0.09, 0.18) and 0.09 (0.07, 0.12) µmol/L, respectively. A total of 126 children had poor VA. The highest tertile of maternal zeaxanthin concentration was associated with 38% lower likelihood of poor VA in children (95% CI: 0.42, 0.93, p-Trends = 0.02). Higher maternal lutein concentrations were associated with a lower likelihood of poor VA in children (RR 0.60 (95% CI: 0.40, 0.88) for middle tertile; RR 0.78 (95% CI: 0.51, 1.19) for highest tertile (p-Quadratic = 0.02)). In conclusion, lutein and zeaxanthin status during pregnancy may influence offspring early visual development; but the results require confirmation with further studies, including more comprehensive measurements of macular functions.
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Grzybowski A, Kanclerz P, Tsubota K, Lanca C, Saw SM. A review on the epidemiology of myopia in school children worldwide. BMC Ophthalmol 2020; 20:27. [PMID: 31937276 PMCID: PMC6961361 DOI: 10.1186/s12886-019-1220-0] [Citation(s) in RCA: 180] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 10/14/2019] [Indexed: 01/29/2023] Open
Abstract
Background Due to high prevalence myopia has gained importance in epidemiological studies. Children with early onset are at particular risk of complications associated with myopia, as progression over time might result in high myopia and myopic macular degeneration. Both genetic and environmental factors play a role in the increasing prevalence of myopia. The aim of this study is to review the current literature on epidemiology and risk factors for myopia in school children (aged 6–19 years) around the world. Main body PubMed and Medline were searched for the following keywords: prevalence, incidence, myopia, refractive error, risk factors, children and visual impairment. English language articles published between Jan 2013 and Mar 2019 were included in the study. Studies were critically reviewed for study methodology and robustness of data. Eighty studies were included in this literature review. Myopia prevalence remains higher in Asia (60%) compared with Europe (40%) using cycloplegic refraction examinations. Studies reporting on non-cycloplegic measurements show exceptionally high myopia prevalence rates in school children in East Asia (73%), and high rates in North America (42%). Low prevalence under 10% was described in African and South American children. In recent studies, risk factors for myopia in schoolchildren included low outdoor time and near work, dim light exposure, the use of LED lamps for homework, low sleeping hours, reading distance less than 25 cm and living in an urban environment. Conclusion Low levels of outdoor activity and near work are well-established risk factors for myopia; this review provides evidence on additional environmental risk factors. New epidemiological studies should be carried out on implementation of public health strategies to tackle and avoid myopia. As the myopia prevalence rates in non-cycloplegic studies are overestimated, we recommend considering only cycloplegic measurements.
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Affiliation(s)
- Andrzej Grzybowski
- Department of Ophthalmology, University of Warmia and Mazury, Olsztyn, Poland. .,Foundation for Ophthalmology Development, Institute for Research in Ophthalmology, Gorczyczewskiego 2/3, 60-554, Poznan, Poland.
| | | | - Kazuo Tsubota
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan.,Tsubota Laboratory, Inc., Tokyo, Japan
| | - Carla Lanca
- Singapore Eye Research Institute, Singapore, Singapore
| | - Seang-Mei Saw
- Singapore Eye Research Institute, Singapore, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
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30
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Wen L, Cheng Q, Lan W, Cao Y, Li X, Lu Y, Lin Z, Pan L, Zhu H, Yang Z. An Objective Comparison of Light Intensity and Near-Visual Tasks Between Rural and Urban School Children in China by a Wearable Device Clouclip. Transl Vis Sci Technol 2019; 8:15. [PMID: 31772826 PMCID: PMC6859833 DOI: 10.1167/tvst.8.6.15] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 09/22/2019] [Indexed: 12/19/2022] Open
Abstract
Purpose To compare light intensity and near-visual tasks objectively between rural and urban children. Methods Clouclip, a wearable device, was applied to assess metrics of these two factors in 78 fifth-grade students from an urban and from a rural school. Results The light intensity experienced by urban students was found significantly lower both in the school period (614.05 ± 178.77 vs. 918.41 ± 257.81 lux, P < 0.001) and on the weekend (444.53 ± 216.65 vs. 882.21 ± 536.67 lux, P < 0.001). The duration of exposure to bright light (>1000 lux) was also substantially shorter for urban students. Although no significant difference was found in near work–related behaviors during the school period and the weekend, for the after-school period the urban students had a shorter average viewing distance (30.94 ± 4.14 vs. 34.81 ± 3.93 cm, P < 0.001), a longer accumulated duration of near work (2.25 ± 0.53 vs. 1.95 ± 0.46 hours, P = 0.010), a greater time ratio of near work (56% ± 14% vs. 49% ± 14%, P = 0.045), and a greater time ratio of excessively close near work (49% ± 13% vs. 40% ± 12%, P = 0.001). Conclusions Our data indicate there were substantial differences in light exposure and near-work metrics between the two regions. The correlation between these differences and the discrepancy in regional myopia prevalence needs further investigation. Translational Relevance The objective quantification of these metrics might help explain the varied myopia prevalence among regions.
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Affiliation(s)
- Longbo Wen
- Aier School of Ophthalmology, Central South University, Hunan, China
| | - Qian Cheng
- State Key Laboratory of Software Development Environment, Beihang University, Beijing, China
| | - Weizhong Lan
- Aier School of Ophthalmology, Central South University, Hunan, China.,Aier School of Optometry and Vision Science, Hubei University of Science and Technology, Hubei, China
| | - Yingpin Cao
- Aier School of Ophthalmology, Central South University, Hunan, China
| | - Xiaoning Li
- Aier School of Ophthalmology, Central South University, Hunan, China.,Aier School of Optometry and Vision Science, Hubei University of Science and Technology, Hubei, China
| | - Yiqiu Lu
- Aier School of Ophthalmology, Central South University, Hunan, China
| | - Zhenghua Lin
- Aier School of Ophthalmology, Central South University, Hunan, China
| | - Lun Pan
- Aier School of Ophthalmology, Central South University, Hunan, China.,Aier School of Optometry and Vision Science, Hubei University of Science and Technology, Hubei, China
| | - Haogang Zhu
- State Key Laboratory of Software Development Environment, Beihang University, Beijing, China
| | - Zhikuan Yang
- Aier School of Ophthalmology, Central South University, Hunan, China.,Aier School of Optometry and Vision Science, Hubei University of Science and Technology, Hubei, China
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31
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Hamm LM, Langridge F, Black JM, Anstice NS, Vuki M, Fakakovikaetau T, Grant CC, Dakin SC. Evaluation of vision screening of 5-15-year-old children in three Tongan schools: comparison of The Auckland Optotypes and Lea symbols. Clin Exp Optom 2019; 103:353-360. [PMID: 31489704 PMCID: PMC7216869 DOI: 10.1111/cxo.12958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 03/13/2019] [Accepted: 07/26/2019] [Indexed: 12/03/2022] Open
Abstract
Background Comprehensive vision screening programmes for children are an important part of public health strategy, but do not exist in many countries, including Tonga. This project set out to assess: (1) the functional vision of children attending primary schools in Tonga and (2) how a new recognition acuity test (The Auckland Optotypes displayed on a tablet computer) compares to use of a standardised eye chart in this setting. Methods Children from three Tongan primary schools were invited to participate. Acuity testing was conducted using a standardised recognition acuity chart (Lea symbols) and the tablet test displaying two formats of The Auckland Optotypes. Measures of ocular alignment, stereo acuity and non‐cycloplegic photorefraction were also taken. Results Parents of 249 children consented to participate. One child was untestable. Only 2.8 per cent of testable children achieved visual acuity worse than 0.3 logMAR in the weaker eye. Results from the Spot Photoscreener suggested that no children had myopia or hyperopia, but that some children had astigmatism. The tablet test was practical in a community setting, and showed ±0.2 logMAR limits of agreement with the Lea symbols chart. Conclusion The sample of children in Tongan primary schools had good functional vision. A modified version of the tablet acuity test is a promising option for vision screening in this context.
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Affiliation(s)
- Lisa M Hamm
- School of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand.,New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand
| | - Fiona Langridge
- Department of Paediatrics: Child and Youth Health and Pacific Health Section, School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Joanna M Black
- School of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand.,New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand
| | - Nicola S Anstice
- School of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand.,New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand.,Discipline of Optometry and Vision Science, University of Canberra, Canberra, Australia
| | - Mele Vuki
- Vaiola Eye Clinic, Vaiola Hospital, Tofoa, Tongatapu, Tonga
| | | | - Cameron C Grant
- Department of Paediatrics: Child and Youth Health and Centre for Longitudinal Research - He Ara ki Mua, The University of Auckland, Auckland, New Zealand.,Department of Paediatrics, General Paediatrics, Starship Children's Hospital, Auckland, New Zealand
| | - Steven C Dakin
- School of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand.,New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand.,UCL Institute of Ophthalmology, University College London, London, UK
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32
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Lanca C, Teo A, Vivagandan A, Htoon HM, Najjar RP, Spiegel DP, Pu SH, Saw SM. The Effects of Different Outdoor Environments, Sunglasses and Hats on Light Levels: Implications for Myopia Prevention. Transl Vis Sci Technol 2019; 8:7. [PMID: 31360613 DOI: 10.1167/tvst.8.4.7] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 05/27/2019] [Indexed: 02/05/2023] Open
Abstract
Purpose Lack of outdoor time is a known risk factor for myopia. Knowledge of the light levels reaching the eye and exposure settings, including sun-protective measures, is essential for outdoor programs and myopia. We evaluated the impact of sun-protective strategies (hat and sunglasses) on maintaining high illuminance levels to prevent myopia. Methods A child-sized mannequin head was developed to measure light illuminance levels with and without sun-protective equipment, across a wide range of environments in Singapore, outdoors (open park, under a tree, street) and indoors (under a fluorescent illumination with window, under white LED-based lighting without window). A comparison was made between indoor and outdoor light levels that are experienced while children are involved in day-to-day activities. Results Outdoor light levels were much higher (11,080-18,176 lux) than indoors (112-156 lux). The higher lux levels protective of myopia (>1000 lux) were measured at the tree shade (5556-7876 lux) and with hat (4112-8156 lux). Sunglasses showed lux levels between 1792 and 6800 lux. Although with sunglasses readings were lower than tree shade and hat, light levels were still 11 to 43 times higher than indoors. Conclusions Recommendations on spending time outdoors for myopia prevention with adequate sun protection should be provided while partaking in outdoor activities, including protection under shaded areas, wearing a hat or sunglasses, sunscreen, and adequate hydration. Translational Relevance Light levels outdoors were higher than indoors and above the threshold illuminance for myopia prevention even with adequate sun-protective measures.
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Affiliation(s)
| | - Aaron Teo
- University of Southampton Malaysia (UoSM), Johor, Malaysia
| | | | - Hla M Htoon
- Singapore Eye Research Institute, Singapore.,Duke-NUS Medical School, Eye ACP, Singapore
| | - Raymond P Najjar
- Singapore Eye Research Institute, Singapore.,Duke-NUS Medical School, Eye ACP, Singapore
| | - Daniel P Spiegel
- Vision Sciences, Essilor R&D, Center for Innovation and Technology, Singapore
| | - Suan-Hui Pu
- University of Southampton Malaysia (UoSM), Johor, Malaysia
| | - Seang-Mei Saw
- Singapore Eye Research Institute, Singapore.,Duke-NUS Medical School, Eye ACP, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
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33
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Harrington SC, O'Dwyer V. Ocular biometry, refraction and time spent outdoors during daylight in Irish schoolchildren. Clin Exp Optom 2019; 103:167-176. [PMID: 31187504 DOI: 10.1111/cxo.12929] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 04/10/2019] [Accepted: 04/23/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Previous studies have investigated the relationship between ocular biometry and spherical equivalent refraction in children. This is the first such study in Ireland. The effect of time spent outdoors was also investigated. METHODS Examination included cycloplegic autorefraction and non-contact ocular biometric measures of axial length, corneal radius and anterior chamber depth from 1,626 children in two age groups: six to seven years and 12 to 13 years, from 37 schools. Parents/guardians completed a participant questionnaire detailing time spent outdoors during daylight in summer and winter. RESULTS Ocular biometric data were correlated with spherical equivalent refraction (axial length: r = -0.64, corneal radius: r = 0.07, anterior chamber depth: r = -0.33, axial length/corneal radius ratio: r = -0.79, all p < 0.0001). Participants aged 12-13 years had a longer axial length (6-7 years 22.53 mm, 12-13 years 23.50 mm), deeper anterior chamber (6-7 years 3.40 mm, 12-13 years 3.61 mm), longer corneal radius (6-7 years 7.81 mm, 12-13 years 7.87 mm) and a higher axial length/corneal radius ratio (6-7 years 2.89, 12-13 years 2.99), all p < 0.0001. Controlling for age: axial length was longer in boys (boys 23.32 mm, girls 22.77 mm), and non-White participants (non-White 23.21 mm, White 23.04 mm); corneal radius was longer in boys (boys 7.92 mm, girls 7.75 mm); anterior chamber was deeper in boys (boys 3.62 mm, girls 3.55 mm, p < 0.0001), and axial length/corneal radius ratios were higher in non-White participants (non-White 2.98, White 2.94, p < 0.0001). Controlling for age and ethnicity, more time outdoors in summer was associated with a less myopic refraction, shorter axial length, and lower axial length/corneal radius ratio. Non-White participants reported spending significantly less time outdoors than White participants (p < 0.0001). CONCLUSION Refractive error variance in schoolchildren in Ireland was best explained by variation in the axial length/corneal radius ratio with higher values associated with a more myopic refraction. Time spent outdoors during daylight in summer was associated with shorter axial lengths and a less myopic spherical equivalent refraction in White participants. Strategies to promote daylight exposure in wintertime is a study recommendation.
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Affiliation(s)
- Síofra C Harrington
- School of Physics and Clinical and Optometric Sciences, Technological University Dublin, Dublin, Ireland
| | - Veronica O'Dwyer
- School of Physics and Clinical and Optometric Sciences, Technological University Dublin, Dublin, Ireland
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